The Cost of an Ultrasound or Sonogram for Pregnancy

Sonograms are the images produced by an ultrasound, which is a routine procedure in many pregnancies. Ultrasounds are a standard part of pregnancy care, but they are not cheap. If you have insurance, you may have to pay some out-of-pocket expenses for them. Expectant mothers who do not have insurance will be responsible for all payments. Ultrasounds done in some contexts, such as many hospitals, may incur a procedure charge as well as a physician fee, with the patient responsible for a copay or coinsurance for both.

Ultrasounds for pregnancy

Ultrasounds provide images of the body's internal structures by using high-frequency sound waves. Ultrasounds during pregnancy are frequently performed transvaginally or across the abdomen to visualize the fetus, placenta, and amniotic fluid.

Ultrasounds assess the fetus's age and hence the mother's due date. Furthermore, ultrasounds can detect abnormalities such as ectopic pregnancies or birth defects, as well as track fetal size and position as the due date approaches. Most pregnant women in the United States will have at least one or two sonograms before giving birth, and those with suspected issues or high-risk pregnancies will have many more.

According to the American Academy of Family Physicians, "it is the standard of care in most U.S. communities to offer a single ultrasound examination at 18 to 20 weeks' gestation, even if dating confirmation is not needed."

How much does a pregnancy ultrasound cost?

The "sticker price" of an ultrasound might vary greatly based on where you reside and who is performing the procedure.

The Healthcare Bluebook, which rates fair prices for medical procedures in various sections of the country, indicates that a fetal ultrasound should cost no more than $202. This sum may differ based on the mother's city or state. According to Healthcare Bluebook, a fetal ultrasound in New Jersey might cost over $350, yet it is only $175 in Oklahoma.

The amount you are charged can also vary greatly depending on your service provider. Large hospitals, which have higher administrative expenditures, may charge a larger fee for an ultrasound than a doctor's office or a stand-alone clinic. If you want to know how much your first ultrasound will cost, contact your provider. To keep your charges as low as possible, stay in-network.

If you are uninsured, you must inform your medical practitioner right away. You could also ask if you can negotiate the price or set up a payment plan. The FDA, as well as several medical organizations such as the American Medical Association and the American College of Obstetricians and Gynecologists, advise women to avoid "keepsake sonograms," which may be offered by private companies.

How much does a sonogram cost?

According to the US Department of Health and Human Services, in order to comply with the Affordable Care Act, health insurers must cover preventive care, including "many services necessary for prenatal care," with no cost-sharing.

That means there is no deductible, copay, coinsurance, or out-of-pocket payment to the insured except than the premium. Certain tests, such as screening for gestational diabetes, are mentioned in the legislation and subsequent guidance; however, radiology, which includes ultrasounds, is not specifically mentioned.

The majority of insurance companies have interpreted the Affordable Care Act's obligations for no-cost prenatal coverage to exclude ultrasounds. For example, UnitedHealthcare Community Plan "considers ultrasounds not medically necessary if done solely to determine the fetal sex, or to provide parents with a view and photograph of the fetus." On its website, ultrasounds are not featured as a service for pregnant women.

Your insurer will still cover doctor-prescribed sonograms (but not souvenir ones), indicating that they are medically essential and part of acceptable care. However, depending on the nature of your plan, you may be required to pay for some, or all, of them yourself.

What to expect, when you’re expecting to pay some part of your sonograms

The cost of your prenatal ultrasounds is determined by both the cost of the procedure at your provider and the payment structure of your health insurance plan.

Again, if you don't have health insurance or choose a completely optional ultrasound (say, to find out the gender of your kid), you'll have to pay the entire cost out of pocket, with no assistance from insurance. In certain circumstances, you can directly negotiate with ultrasound providers, so ask them for their best rate.

If your doctor prescribed an ultrasound, you may have to pay for it as part of your deductible before your insurance plan would cover it. Otherwise, you will pay your plan’s predetermined copay or coinsurance percentage. You’re only home-free after you’ve reached your plan’s out-of-pocket limits for the year. After that, insurance should pay for all of your health care in its entirety. A physician or radiologist fee may be charged for ultrasounds performed at a larger hospital.

Copays and coinsurance costs

Because of the differences between plans, it's critical to double-check the specifics of your own so you know what you'll end up paying. If you want to keep your costs as low as possible, it's also critical to get all of your care from in-network providers, as out-of-network options can result in even higher out-of-pocket charges.

Keep in mind that if your pregnancy covers two calendar years (for example, if you become pregnant in September and deliver in June of the following year), you will be liable to your deductible, copays, and coinsurance for both calendar years.

To estimate your worst-case situation (which is common if you need several tests throughout your pregnancy), multiply your out-of-pocket maximum by two.

Consider your annual premiums, which are not included in the out-of-pocket maximum. When you know you'll be receiving a lot of medical treatment, it may make sense to switch to a plan with a smaller out-of-pocket cost cap.